Provider Demographics
NPI:1376640649
Name:ADVANCED HOME CARE PLUS LLC
Entity Type:Organization
Organization Name:ADVANCED HOME CARE PLUS LLC
Other - Org Name:ADVANCED HOME CARE PLUS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-2727
Mailing Address - Street 1:2401 TEE CIR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6207
Mailing Address - Country:US
Mailing Address - Phone:405-928-2727
Mailing Address - Fax:405-928-2720
Practice Address - Street 1:6330 E 75TH ST
Practice Address - Street 2:SUITE 334
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2777
Practice Address - Country:US
Practice Address - Phone:317-585-5730
Practice Address - Fax:317-585-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN157566Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER